论文部分内容阅读
目的探讨混合型肝细胞-胆管细胞癌的临床特征、诊断及外科治疗效果。方法 2000年1月～2010年12月间中国医学科学院肿瘤医院经手术病理学检查证实的混合型肝细胞-胆管细胞癌患者23例,对其临床、病理、生存情况以及复发情况等相关资料进行回顾性分析。结果 23例患者中有22例接受剖腹探查肝切除术或联合淋巴结清扫术(7例),另外1例采用腹腔镜下肝脏肿瘤切除术。除1例围手术期死亡外,其余22例患者中16例出现复发。术后中位生存时间及中位无复发生存时间分别为15.00(0.37～116.00)及5.00(0.37～116.00)个月;1、3、5年的总体生存率及无复发生存率分别为62.7%,35.8%,23.9%和40.9%,30.7%,15.3%。复发后患者的中位生存时间仅为5.04(1.5～65.0)个月。将可能影响患者预后的因素进行单因素分析及Log-rank检验,结果显示:肝炎肝硬化合并长期饮酒、术中输血、手术切缘阳性、病理分期较晚以及影响分期的因素如肿瘤直径>5cm、多发肿瘤等多个因素与患者的不良预后有关,而CEA>5ng/ml、肿瘤穿透肝被膜等同样可能影响患者生存。结论本病缺乏特异性临床表现,术前明确诊断较为困难。混合型肝细胞-胆管细胞癌预后不佳。根治性手术是其有效治疗手段,这其中多个因素与不良的预后有关。
Objective To investigate the clinical features, diagnosis and surgical treatment of mixed hepatocellular carcinoma (cholangiocarcinoma). Methods Twenty-three patients with hepatocellular cholangiocarcinoma confirmed by pathological examination at Cancer Hospital of Chinese Academy of Medical Science from January 2000 to December 2010 were studied retrospectively. The clinical, pathological, survival and recurrence were analyzed Retrospective analysis. Results Twenty-three of the 23 patients underwent laparotomy hepatectomy or lymph node dissection (n = 7), and the other one underwent laparoscopic hepatectomy. In addition to a perioperative death, the remaining 22 patients in 16 cases of recurrence. The median postoperative survival and median recurrence-free survival were 15.00 (0.37-116.00) and 5.00 (0.37-116.00) months, respectively. The overall and recurrence-free survival rates at 1, 3 and 5 years were 62.7% , 35.8%, 23.9% and 40.9%, 30.7% and 15.3% respectively. The median survival time after relapse was only 5.04 (1.5-65.0) months. The factors that may affect the prognosis of patients were analyzed by univariate analysis and Log-rank test. The results showed that: hepatitis cirrhosis with long-term alcohol consumption, intraoperative blood transfusion, positive surgical margins, late stage of the pathology and factors affecting the staging, such as tumor diameter> 5cm , Multiple tumors and other factors related to the poor prognosis of patients, and CEA> 5ng / ml, tumor penetrating the liver capsule may also affect the survival of patients. Conclusion The disease lacks specific clinical manifestations, preoperative diagnosis is more difficult. Mixed hepatocytes - cholangiocarcinomas have a poor prognosis. Radical surgery is its effective treatment, many of which are associated with poor prognosis.